Swallowing dysfunctions in patients with disorders of consciousness: Evidence from neuroimaging data, assessment, and management.

Following severe brain injuries, a subset of patients may remain in an altered state of consciousness; most of these patients require artificial feeding. Currently, a functional oral phase and the presence of exclusive oral feeding may constitute signs of consciousness. Additionally, the presence of pharyngo-laryngeal secretions, saliva aspiration, cough reflex and tracheostomy are related to the level of consciousness.

[Globus pharyngeus : etiologies, diagnosis and management. A narrative review].

Globus pharyngeus is a very common symptom in the general population. It is defined as a sensation of lump or foreign body in the throat, generally not accompanied by pain and relieved by eating. This last notion makes the differential diagnosis with dysphagia, which requires a different management.

Links Between Swallowing and Consciousness: A Narrative Review.

This literature review explores a wide range of themes addressing the links between swallowing and consciousness. Signs of consciousness are historically based on the principle of differentiating reflexive from volitional behaviors. We show that the sequencing of the components of swallowing falls on a continuum of voluntary to reflex behaviors and we describe several types of volitional and non-volitional swallowing tasks.

Vibration, a treatment for migraine, linked to calpain driven changes in actin cytoskeleton.

Understanding how a human cell reacts to external physical stimuli is essential to understanding why vibration can elicit localized pain reduction. Stimulation of epithelial cells with external vibration forces has been shown to change cell shape, particularly in regards to structures involved in non-muscle cell motility. We hypothesized that epithelial cells respond to vibration transduction by altering proteins involved in remodeling cytoskeleton.

The Development and Validation of the SWADOC: A Study Protocol for a Multicenter Prospective Cohort Study.

After a coma, patients with severe brain injury may present disorders of consciousness (DOC). A substantial proportion of these patients also suffer from severe dysphagia. Assessment of and therapy for swallowing disabilities of patients with DOC are essential because dysphagia has major functional consequences and comorbidities.

[Benefits and limitations of geriatric dysphagia screening tools].

This prospective study aims to evaluate both benefits and limitations of dysphagia screening tools (DePippo, EAT10, V-VST, the IOPI tongue-strength assessment) used in a geriatric unit. Among the 102 patients under study, 47 showed a dysphagia diagnosed by full logopedic examination. The sensitivity and the specificity of the screening tools were, respectively, 31,9 % and 83,6 % for EAT10, 86,9 % and 52,7 % for the V-VST and 76,6 % and 65,0 % for the DePippo test.

Swallowing function after severe COVID-19: early videofluoroscopic findings.

Introduction: The aim of this paper is to describe the early findings of swallowing analysis with videofluoroscopy of swallowing (VFS).

Methods: The 21 first patients (14 men and 7 women) who recovered from ARDS in context of COVID-19 were referred to VFS just before to maximum 14 days after their discharge from ICU. The swallowing impairments and the physiopathologic mechanism of them were prospectively analyzed by two swallowing experts: one radiologist, and one phoniatrician using penetration-aspiration scale (PAS) score.

Swallowing in individuals with disorders of consciousness: A cohort study.

Background: After a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with disorders of consciousness (DOC) classically receive hydration and nutrition through an enteral-feeding tube. However, the real impact of the level of consciousness on an individual's swallowing ability remains poorly investigated.

Guidelines of clinical practice for the management of swallowing disorders and recent dysphonia in the context of the COVID-19 pandemic.

Procedures putting healthcare workers in close contact with the airway are particularly at risk of contamination by the SARS-Cov-2 virus, especially when exposed to sputum, coughing, or a tracheostomy. In the current pandemic phase, all patients should be considered as potentially infected. Thus, the level of precaution recommended for the caregivers depends more on the type of procedure than on the patient's proved or suspected COVID-19 status.

Early Management of Acute Unilateral Vocal Fold Paralysis: Update of the Literature.

Background: Unilateral vocal fold paralysis (UVFP) often leads to significant morbidity that may include dysphonia, swallowing problems and aspiration. The best timing for medialization procedures is still controversial. Published data suggest that early intracordal injection positively affects long-term outcomes.

Contact Pressure Between the Vocal Folds in Reinke's Edema: Experimental Observations on an Excised Human Larynx.

Objective: To analyze the range of values of the contact pressure between the membranous vocal folds with Reinke's edema and to compare it to those observed in the absence of such a lesion.

Methods: Two human larynges were separately tested on the experimental bench, one of them with a bilateral loose swelling of the vocal folds. Once in a glottal prephonatory configuration, airflow was increased until achievement of self-sustained oscillations while recording aerodynamic, acoustic, electroglottographic data, and contact pressure between the folds.

Prevalence and characterisation of vocal fold motion impairment (VFMI) in patients with Multiple system atrophy compared with Parkinson's disease.

Introduction: Multiple system atrophy (MSA) is a neurodegenerative disorder in which vocal fold mobility can be affected, sometimes leading to life-threatening situations. Our aim was to know if laryngeal examination could help differentiate MSA from Parkinson's disease (PD).

Materials And Methods: Between 2004 to 2014, all consecutive patients diagnosed with probable MSA were included in this retrospective, monocentric study.

[An unexpected discovery of laryngeal neurofibroma during intubation for elective surgery].

We report the unexpected discovery of a large laryngeal neurofibroma during a direct laryngoscopy for intubation in a 18-year old female with a medical history of neurofibromatosis type 1. The most striking feature of this case report is the discrepancy between the absence of clinical manifestations and the size and location of the neurofibroma. This case highlights the importance of a careful preoperative assessment, especially in the context of multisystemic disease.

Acoustic correlates of vocal effort: External factors and personality traits.

Objectives: To develop an experimental protocol to study the vocal effort generated by introducing barriers to communication, and its relationship with certain personality traits.

Material And Methods: The experimental protocol consisted of an interactive game in which the subject gave an investigator instructions to adopt various body positions (semi-directed communication situation). The Control situation included no constraints on communication.

Control of the glottal configuration in ex vivo human models: quantitative anatomy for clinical and experimental practices.

Introduction: The objective of this paper was to identify the determining factors of the glottal prephonatory configuration from the point of view of the resulting muscular actions (i.e., arytenoids adduction, membranous vocal fold adduction, and tension).

A dynamic study of the anterior cruciate ligament of the knee using an open MRI.

Recent anatomical and radiological studies of the anterior cruciate ligament (ACL) suggest the ACL length and orientation change during knee flexion, and an open MRI sequencing during knee flexion enables a dynamic ACL analysis. This study's goal is to describe a normal ACL using a 1T open MRI and, in particular, variations in length and insertion angles at different degrees of flexion. Twenty-one volunteers with clinically healthy knees received a dynamic MRI with their knees in hyperextension, neutral position, and flexed at 45° and 90° angles.

The shouted voice: A pilot study of laryngeal physiology under extreme aerodynamic pressure.

Introduction: The objective was to study the behavior of the larynx during shouted voice production, when the larynx is exposed to extremely high subglottic pressure.

Materials And Methods: The study involved electroglottographic, acoustic, and aerodynamic analyses of shouts produced at maximum effort by three male participants.

Results And Discussion: Under a normal speaking voice, the voice sound pressure level (SPL) is proportional to the subglottic pressure.

Histological identification of nasopharyngeal mechanoreceptors.

The auditory tube plays a fundamental role in regulating middle ear pressure. A "system" sensitive to a pressure gradient between the middle ear and the ambient environment is necessary. The presence of mechanoreceptors in the middle ear and the tympanic membrane has been studied, but the presence of these receptors in the nasopharyngeal region remains unclear.

A cell-based screening assay to identify pharmaceutical compounds that enhance the regenerative quality of corneal repair.

The goal of this study was to develop and validate a simple but quantitative cell-based assay to identify compounds that might be used pharmaceutically to give tissue repair a more regenerative character. The cornea was used as the model, and some specific aspects of repair in this organ were incorporated into assay design. A quantitative cell-based assay was developed based on transcriptional promoter activity of fibrotic marker genes ACT2A and TGFB2.